Indiana Announces RUGs IV Trainings

As previously reported, Indiana Medicaid is transitioning the NF rate system from RUGs III to RUGs IV with an expected effective date of July 1, 2015.  While the details on which RUGs IV Grouper is being used and how the State intends to pay for the transition are still up in the air, Indiana Medicaid’s contractor, Myers & Stauffer, has announced 7 trainings around the state beginning in mid-April to discuss the chosen RUGs IV Grouper, draft Supportive Documentation Guidelines, draft Time-Weighted Guidelines, Case Mix Documentation Review Protocol, and an update on e450B.  Click here for the registration form and information.

Indiana Medicaid Processes Certain 10/1/13 Retro Claims in Error

Indiana Medicaid’s claims processing contractor, HP, announced on March 31, 2014 that it incorrectly processed Remittance Advices dated April 1, 2014 for retroactive rate adjustments in error.  The error is to be corrected, without facilities having to resubmit claims, by April 7, 2014.  The retroactive adjustments are being made as the new Medicaid Value Based Purchasing Add-on is implemented.  It is IHCA’s understanding that the error only impacted 154 facilities, but that information is not posted on the State’s website.  The State did post the following message on Indianamedicaid.com:

On the Remittance Advices dated April 1, 2014, a retroactive rate adjustment caused accounts receivables (ARs) to be set up in error. This issue has been identified and is being corrected by HP. Although some providers were advised to resubmit the affected claims, it has been determined these claims should NOT be resubmitted. Paid claims are being reprocessed by HP. The reprocessed claims will be reported on the Remittance Advices dated April 7, 2014.

Congress Passes 1 year Doc Fix – Contains SNF Value Based Purchasing Program

On the evening of March 31st, the Senate approved the already approved House version of the Doc Fix that averted a 24% rate cut to physicians.  The “fix” is for one year, until April 1, 2015.  The measure also included an extension of the therapy cap exception and an AHCA-influenced hospital readmission policy that is being labeled as SNF Value Based Purchasing that will begin on Oct. 1, 2018.  The SNF VBP program calls for a 2% rate cut, but with at least 50% and up to 70% of that rate cut being allocated to an incentive pool to reward SNFs based on performance on a hospital readmission measure.  There are a number of details still to come from CMS on how the ultimate program will work.  To read a detailed memo from AHCA President Mark Parkinson, click here.

QAPI Process Tool Framework released by CMS

CMS has created “process” tools that may be used to implement and apply some of the basic principles of QAPI.  A Process Tool Framework has been created to crosswalk each CMS Process Tool to the QAPI Five Elements. This framework includes a description of the purpose or goal for each tool that is hyperlinked within the framework. For more information click the Tools link on this page.

Residential Care Citation Update

The ISDH cited 18 Deficiency tags in February in Residential Care Facilities.  No Offense tags were cited in February.  Tag 0117 concerning sufficient and qualified staff to meet the 24 hour scheduled and unscheduled needs of residents was cited 3 times in February.  At the time of this writing, the survey reports were not yet released on these three citations.  Tag 0036 concerning contacting the resident’s physician and legal representative after noticing a significant decline in resident status was cited 2 times in February. Tags 0214 and 0217 concerning resident evaluation and services plan were each cited 2 times in February. 

For the first two months of 2014, the leading Residential Care Deficiency and Offense tags are:
• Tag 0273 (food preparation and service areas) – Cited 4 times
• Tag 0241 (administration of medications by licensed personnel) – Cited 4 times
• Tag 0036 (physician/legal rep contact after significant decline) – Cited 4 times
• Tag 0214 (initiation/updating of resident evaluation) – Cited 3 times
• Tag 0217 (service plan completeness, review, resident agreement) – Cited 3 times
• Tag 0117 (sufficient and qualified staff to meet 24 hour need) – Cited 3 times

To view a summary of the February citations, click here.

CMS Issues Guidance Concerning Home and Community Based Services Settings

 CMS issued new guidance Monday in the form of a “Home and Community Based Settings Toolkit” to assist states with the process states they follow for developing their 1915 (c) and 1915 (i) waiver plan amendments and renewal applications.  The toolkit is designed to help states determine which settings will be considered home- and community-based settings (HCBS).   The components of the five-piece tool kit can be found at the bottom of the home page at  www.medicaid.gov/hcbs. 
Also, a PDF of the toolkit may be accessed by clicking here.

The agency further describes the qualities HCBS settings and the options that must be provided by states to Medicaid beneficiaries.  Specifically, CMS spells out those settings that are presumed to have the qualities of an institution and will fall under “heightened scrutiny” for both waiver programs.  The guidance includes decision trees for states to follow in making heightened scrutiny determinations for the transition plan process and the standard waiver process.